Implementing a Suicide Audit in Montreal: Taking Suicide Review Further to Make Concrete Recommendations for Suicide Prevention

Abstract

Objective

A suicide audit was pilot implemented in order to generate recommendations on how to improve suicide prevention.

Methods

Thirty-nine consecutive suicides that occurred in Montreal, Canada from January to October 2016 were audited. A retrospective analysis of their life trajectory and service utilization was conducted using the psychological autopsy method, which included interviewing suicide-bereaved survivors and examining health and social services records and the coroner’s investigation file. A psychosocial and service utilization profile was drawn for each decedent. A multidisciplinary panel reviewed each case summary to identify gaps in terms of individual intervention, provincial public health and social services, and regional programs.

Results

Five main suicide prevention recommendations were made to prevent similar suicides: (1) deploy mobile crisis intervention teams (short-term, high-intensity, home-based treatment) in hospital emergency departments; (2) train primary and specialized mental health care professionals to screen for and manage substance use disorders; and (3) implement public awareness campaigns to encourage help seeking for depression and substance use disorders; (4) access for all, regardless of age, to an effective psychosis treatment program; and (5) provide universal access to a general practitioner, especially for men.

Conclusions

The suicide audit procedure was implemented effectively and targeted recommendations were generated to prevent similar suicides. However, resistance from medical and hospital quality boards arose during the process, though these could be allayed if regional and provincial authorities actively endorsed the multidisciplinary and multi stakeholders suicide audit process.

Highlights

• A bottom-up approach to generate recommendations for suicide prevention.

• Implementation was challenging with resistance to our interdisciplinary approach.

• The audit needs the support of the regional health department to lift barriers.

Keywords:

• Healthcare utilization
• mental health services
• substance use disorders
• suicide
• quality of care

ACKNOWLEDGEMENTS

The authors thank the staff of the Quebec Coroner’s Office, the Quebec Association for Suicide Prevention, Mr. Michael Sheehan (spokesperson for the Coalition for Access to Psychotherapy) and the suicide bereaved survivors who participated in the audit process. Dr Christophe Tra translated the NCISH questionnaire.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

AUTHOR NOTES

Alain Lesage, M.D., M. Phil., Department of Psychiatry, Université de Montréal, Institut universitaire en santé mentale de Montréal, Montreal, Canada.

Gabrielle Fortin, B. Eng., Institut universitaire en santé mentale de Montréal, Montréal, Canada.

Fabienne Ligier, M.D., Ph.D., Centre Psychothérapique de Nancy, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Lorraine, France; Université de Lorraine, EA 4360 APEMAC, Lorraine, France.

Ian Van Haaster, Ph.D., Institut universitaire en santé mentale de Montréal, Programme des troubles anxieux et de l’humeur, Montréal, Canada.

Claude Doyon, B. Sc., Charlie Brouillard, Ph. D., Diane Daneau, RN, M. Sc., Institut universitaire en santé mentale de Montréal, Montréal, Canada.

Jessica Rassy, RN, Ph. D., Institut universitaire en santé mentale de Montréal, Montréal, Canada; School of Nursing, Université de Sherbrooke, Longueuil, Canada

DATA AVAILABILITY STATEMENT

Please contact the corresponding author for access to the anonymized narratives and standardized needs assessment score sheets. Coroner and medical files are confidential and cannot be accessed.

Additional information

Funding

This project was supported by the Montreal Regional Directorate of Public Health who provided a grant for logistics only. The East-End Montreal Integrated University Health and Social Services Center supported the project by allocating staff (authors IVH and CD). Author GF received PREMIER grants from the Université de Montréal summer research internship program. Dr Ligier received post-doctoral fellowship grant from the Quebec Network on Suicide, Mood Disorders and Associated Disorders.